Aortic geometry and long-term outcome in patients with a repaired coarctation.

Autor:	Minderhoud SCS; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands., van Montfoort R; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands., Meijs TA; Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands., Korteland SA; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands., Bruse JL; Vicomtech Foundation, Basque Research and Technology Alliance, Donostia-San Sebastián, Spain., Kardys I; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands., Wentzel JJ; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands., Voskuil M; Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands., Hirsch A; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.; Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands., Roos-Hesselink JW; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands., van den Bosch AE; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands a.e.vandenbosch@erasmusmc.nl.
Jazyk:	angličtina
Zdroj:	Open heart [Open Heart] 2024 May 28; Vol. 11 (1). Date of Electronic Publication: 2024 May 28.
DOI:	10.1136/openhrt-2024-002642
Abstrakt:	Objective: This study aims to compare aortic morphology between repaired coarctation patients and controls, and to identify aortic morphological risk factors for hypertension and cardiovascular events (CVEs) in coarctation patients. Methods: Repaired coarctation patients with computed tomography angiography (CTA) or magnetic resonance angiography (MRA) were included, followed-up and compared with sex-matched and age-matched controls. Three-dimensional aortic shape was reconstructed using patients' CTA or MRA, or four-dimensional flow cardiovascular magnetic resonance in controls, and advanced geometrical characteristics were calculated and visualised using statistical shape modelling. In patients, we examined the association of geometrical characteristics with (1) baseline hypertension, using multivariable logistic regression; and (2) cardiovascular events (CVE, composite of aortic complications, coronary artery disease, ventricular arrhythmias, heart failure hospitalisation, stroke, transient ischaemic attacks and cardiovascular death), using multivariable Cox regression. The least absolute shrinkage and selection operator (LASSO) method selected the most informative multivariable model. Results: Sixty-five repaired coarctation patients (23 years (IQR 19-38)) were included, of which 44 (68%) patients were hypertensive at baseline. After a median follow-up of 8.7 years (IQR 4.8-15.4), 27 CVEs occurred in 20 patients. Aortic arch dimensions were smaller in patients compared with controls (diameter p<0.001, wall surface area p=0.026, volume p=0.007). Patients had more aortic arch torsion (p<0.001) and a higher curvature (p<0.001). No geometrical characteristics were associated with hypertension. LASSO selected left ventricular mass, male sex, tortuosity and age for the multivariable model. Left ventricular mass (p=0.014) was independently associated with CVE, and aortic tortuosity showed a trend towards significance (p=0.070). Conclusion: Repaired coarctation patients have a smaller aortic arch and a more tortuous course of the aorta compared with controls. Besides left ventricular mass index, geometrical features might be of importance in long-term risk assessment in coarctation patients. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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